Buncombe County announces four monkeypox cases

Buncombe County has four cases of the monkeypox virus as of July 25, according to N.C. Department of Health and Human Services data.

The county announced its first monkeypox case July 21. In a media briefing July 22, Buncombe County Health and Human Services Public Health Director Stacie Saunders said that affected individual was isolating and the department was conducting contact tracing with the individual’s acquaintances. She said BCDHHS would not release further information about the individual at this time.

North Carolina has 53 cases of monkeypox as of July 29, according to a dashboard on the NCDHHS website. There have been no reported deaths from monkeypox in the U.S. “Over 99% of people who get [monkeypox] are likely to survive,” Saunders says.

Saunders also said Buncombe County has supplies of the monkeypox vaccine. The NCDHHS designated the BCDHHS and Western North Carolina Community Health Services (also called the Minnie Jones Clinic in Asheville) to administer monkeypox vaccines in Buncombe County.

Called Jynneos, the vaccine requires two doses administered one month apart. An individual is considered protected from the virus two weeks after the second dose.

BCDHHS received 520 dosages of the vaccine; as of July 29, Saunders says it had administered 288 first doses. BCDHHS provided 100 doses to WNCCHS, which serves the 18 counties of Western North Carolina.

The following people are eligible for the monkeypox vaccine: those who have been in close physical contact with someone who has monkeypox in the past 14 days; men who have sex with men or are transgender, especially those who have had multiple or anonymous sex partners; and certain health care and public health workers. The vaccine is available at no cost, and residency in Buncombe County is not required. (The Centers for Disease Control and Prevention recommends an individual be vaccinated prior to exposure, or four-14 days after exposure.)

Testing for monkeypox is “widely available” in Buncombe County, says Saunders, who urged anyone who notices a lesion or rash to get tested at WNCCHS or BCDHHS as a precaution. Individuals also can inquire if their health care providers offer testing. Saunders says the BCHHS communicable disease staff is reporting an average of around 48 hours for turnaround time for lab results .

Vaccines are available at the BCDHHS immunization clinic, 40 Coxe Ave., 8 a.m.-4:30 p.m. Monday-Friday. No appointment is required. Vaccines also are available at the Minnie Jones Health Center, 257 Biltmore Ave., 8 a.m.-5 p.m. Monday-Friday .

Saunders encouraged the public to learn more about the local spread via the DHHS or the CDC websites.

Rash and a fever

Monkeypox can have similar symptoms to influenza, like exhaustion and headache, as well as lymph node swelling and a bumpy rash. The bumps are filled with fluid and then scab or crust over.

The virus can spread through skin-to-skin contact and on items like towels and bedsheets. “Monkeypox virus can be spread person-to-person through infected body fluids (including saliva and lesion fluid), items that have been in contact with infected fluids or lesion crusts, and respiratory droplets,” the NCDHHS website explains.

The appearance of the pox, which resemble blisters or lesions, can be confused with chickenpox or sexually transmitted diseases like herpes or syphilis. The lesions appear most often on the face, hands, feet, mouth, genitals and buttocks, according to the NCDHHS. Complications of monkeypox can include secondary infections, bronchopneumonia, sepsis, encephalitis and vision loss from infection of the cornea, says Saunders.

If an individual suspects exposure to monkeypox, she recommends the person make an appointment with a medical provider, or visit their local public health office, and avoid close contact with anyone else “including skin-to-skin contact like hugging, cuddling, sex and other close intimate contact” until a negative monkeypox test. She also recommends wearing a mask around others, as the virus can spread through respiratory droplets.

An individual with monkeypox “should isolate until rash has fully resolved, the scabs have fallen off, and a fresh layer of intact skin has formed,” Saunders adds.

Not an LGBTQ+ community virus

The outbreak in the U.S. has primarily been among men who have sex with men. (The NCDHHS website regularly updates its monkeypox surveillance data, including an infected person’s age, race and gender.)

Experts emphasize that monkeypox is not a sexually transmitted disease, despite the fact the most cases in the U.S. are among people from the LGBTQ+ community.

“We’re seeing folks label this as a sexually transmitted disease or infection, and that is not the case,” says Jack Hoda, LGBTQ+ health coordinator for WNCCHS. “It’s not been classified as [an STD or STI] because we don’t have real evidence to say that it spreads through sexual fluid.” To that end, monkeypox can “spread much more easily through just cuddling than — evidence says — sex,” he adds.

Hoda says WNCCHS is partnering with local community organizations Blue Ridge Pride, Tranzmission, Campaign for Southern Equality, Western North Carolina AIDS Project and YouthOUTright to educate the LGBTQ+ community about monkeypox.

Between 55,000 and 80,000 WNC residents identify as LGBTQ, according to Blue Ridge Pride.

Monkeypox can infect anyone regardless of their sexual orientation. Explains Mountain Area Health Education Center CEO Bill Hathaway, a “virus and germs attack the next available host regardless of any feature about them.”

In her July 23 brief, Sanders from BCDHHS said that depending on the course of the outbreak, other groups may become eligible for the monkeypox vaccine. “The bottom line is anyone can get monkeypox,” she said.

However, Hathaway predicted monkeypox may not spread as widely as COVID, as this virus has a visible rash allowing individuals to see they are infected.

Local response

As of Aug. 1, WNCCHS administered 49 first doses of the monkeypox vaccine, and had another 19 first doses scheduled, says Hoda. The clinic was chosen to distribute the vaccine because it is already integrated in the local LGBTQ+ community, Kim Wagenaar, chief executive officer of WNCCHS, tells Xpress.

NCDHHS reported the first identified case of monkeypox in a North Carolina resident June 23.

Most monkeypox infections in North Carolina are in Mecklenburg County. But Hoda says WNCCHS has gotten “a steady influx” of inquiries  about transmission and vaccination information. (MAHEC spokesperson Michelle Morgan and Blue Ridge Health chief medical officer Dr. MaryShell Zaffino both tell Xpress they’re getting few inquiries. Both health centers can test for monkeypox.)

The U.S. Department of Health and Human Services declared monkeypox a public health emergency Aug. 4. Gov. Roy Cooper not has declared monkeypox a public health emergency in N.C.

“The governor consults with state health officials to guide the state’s response to threats to public health,” Mary Scott Winstead, spokesperson for Cooper’s office, tells Xpress in an email. “NCDHHS has been working with federal and local partners and health providers to increase awareness of monkeypox and protect North Carolinians.”

Global outbreak

Monkeypox was identified in humans in 1970 in the Democratic Republic of Congo, according to the World Health Organization. Primates and rodents originally transmitted the virus to humans through direct contact.

According to the WHO, the first monkeypox outbreak in the U.S. occurred in 2003 among infected pet prairie dogs, which had been housed with rodents in Ghana infected with the virus. Subsequent outbreaks have since occurred globally. (Wagenaar from WNCCHS and Hathaway from MAHEC say their clinics have never treated a monkeypox case.)

The WHO identified a monkeypox outbreak — meaning at least one occurrence in a nonendemic country —  May 16, and the CDC announced the first U.S. monkeypox case in the current outbreak May 18 in Massachusetts. The WHO declared a global health emergency June 23.

The vaccine, Jynneos, was approved by the Food and Drug Administration in 2019.

In a July 21 address to local health directors, NCDHHS Secretary of Health Kody Kinsley shared that monkeypox vaccines were limited in N.C., but the federal government offered assurances more would come. (And the federal Health and Human Services Department has ordered millions more vaccines from the Jynneos manufacturer.)

Saunders said BCDHHS has received three shipments of monkeypox vaccines, one week apart. She said the county anticipates an arrival of more vaccines the week of Aug. 1.

UPDATE, August 5: This article has been updated to state the U.S. Department of Health and Human Services declared monkeypox a public health emergency Aug. 4.